Monday, September 25, 2023
| Characteristic | Current cigarette smokinga | ||||||
|---|---|---|---|---|---|---|---|
| No past-year mental health condition (n = 6,896) | Past-year any mental illnessb (n = 3,983) | Past-year serious mental illness (n = 1,336) | Past-year mild or moderate mental illness (n = 2,647) | Past-year serious psychological distress alone (n = 1,498) | Past-year major depressive disorder alone (n = 303) | Past-year serious psychological distress and major depressive disorder (n = 1,337) | |
| Overall | 13.6 (13.0–14.3) | 22.8 (21.7–23.8) | 27.2 (25.3–29.0) | 21.2 (19.8–22.6) | 24.5 (22.3–26.7) | 17.6 (13.8–21.5) | 25.0 (23.3–26.8) |
| Survey year | |||||||
| 2019 | 14.6 (14.0–15.2) | 25.2 (24.3–26.2) | 30.1 (27.7–32.6) | 23.6 (22.4–24.8) | 27.7 (25.7–29.6) | 18.5 (15.6–21.4) | 27.2 (25.3–29.2) |
| 2020 | 12.7 (11.7–13.7) | 20.3 (18.4–22.1) | 24.3 (20.9–27.7) | 18.9 (16.3–21.4) | 21.3 (17.3–25.3) | 16.7 (9.4–24.0) | 22.9 (20.0–25.9) |
| Age, y | |||||||
| 18–25 | 9.7 (8.9–10.5) | 14.9 (13.8–16.0) | 18.9 (16.6–21.2) | 13.1 (11.8–14.5) | 14.3 (12.4–16.3) | 10.6 (7.6–13.6) | 16.2 (14.1–18.3) |
| 26–34 | 16.5 (15.6–17.4) | 26.1 (24.4–27.9) | 31.6 (27.9–35.4) | 24.1 (22.3–26.0) | 26.7 (23.3–30.1) | 25.1 (15.7–34.6) | 30.2 (26.2–34.1) |
| 35–49 | 17.4 (16.4–18.3) | 27.8 (26.0–29.6) | 34.4 (30.5–38.3) | 25.3 (23.3–27.4) | 31.6 (28.0–35.2) | 21.5 (15.9–27.2) | 32.1 (27.9–36.3) |
| 50–64 | 15.7 (14.4–17.1) | 27.0 (23.4–30.6) | 27.0 (21.6–32.3) | 27.0 (22.3–31.7) | 32.1 (22.3–41.9) | 15.9 (10.1–21.7) | 28.7 (22.2–35.1) |
| ≥65 | 7.7 (6.7–8.8) | 11.6 (8.4–14.7) | — c | 11.8 (8.3–15.4) | 18.1 (8.8–27.4) | — c | 11.8 (4.9–18.6) |
| Sex | |||||||
| Male | 15.8 (15.0–16.6) | 25.5 (23.8–27.1) | 29.1 (26.0–32.1) | 24.3 (22.2–26.3) | 30.1 (26.2–34.0) | 16.4 (12.2–20.6) | 28.0 (25.0–31.0) |
| Female | 11.4 (10.6–12.2) | 21.2 (19.8–22.5) | 26.1 (23.6–28.6) | 19.4 (17.6–21.2) | 20.7 (18.7–22.7) | 18.4 (13.0–23.7) | 23.3 (20.8–25.9) |
| Sexual orientation | |||||||
| Heterosexual | 13.4 (12.7–14.0) | 22.1 (21.0–23.3) | 27.1 (24.9–29.3) | 20.6 (19.1–22.2) | 24.1 (21.8–26.3) | 18.1 (13.9–22.2) | 24.7 (22.8–26.6) |
| Gay/lesbian | 20.7 (16.1–25.2) | 29.2 (23.8–34.6) | 29.3 (19.1–39.5) | 29.2 (21.6–36.7) | 29.4 (20.6–38.2) | — c | 31.3 (21.0–41.7) |
| Bisexual | 22.3 (19.5–25.0) | 25.9 (22.9–28.9) | 28.5 (24.9–32.2) | 23.9 (20.0–27.8) | 26.8 (22.4–31.2) | 17.1 (9.6–24.5) | 25.4 (21.6–29.1) |
| Race/ethnicity | |||||||
| Hispanic | 8.5 (7.6–9.4) | 19.0 (16.0–22.1) | 23.2 (17.8–28.5) | 17.7 (14.1–21.3) | 21.7 (14.7–28.8) | 12.8 (6.1–19.5) | 18.6 (14.2–22.9) |
| Non-Hispanic American Indian, Alaska Native | 26.0 (18.8–33.2) | 53.3 (40.5–66.2) | 59.2 (34.5–83.8) | 50.8 (33.8–67.8) | 71.0 (50.1–92.0) | — c | 40.8 (19.2–62.4) |
| Non-Hispanic Asian | 7.2 (5.1–9.2) | 7.9 (4.5–11.3) | — c | 8.1 (4.2–11.9) | 6.0 (2.8–9.2) | — c | — c |
| Non-Hispanic Black | 16.2 (14.2–18.2) | 21.0 (16.9–25.0) | 17.4 (11.0–23.9) | 22.1 (17.6–26.6) | 24.8 (18.7–30.9) | — c | 15.9 (10.5–21.4) |
| Non-Hispanic multiple races | 23.4 (18.1–28.6) | 29.1 (22.6–35.5) | 32.5 (22.8–42.3) | 27.9 (19.3–36.4) | 22.8 (11.9–33.7) | 23.0 (10.1–35.9) | 26.4 (18.5–34.4) |
| Non-Hispanic Native Hawaiian, Pacific Islander | 13.5 (8.3–18.7) | — c | — c | — c | — c | — c | — c |
| Non-Hispanic White | 14.8 (13.9–15.7) | 24.1 (22.8–25.3) | 29.6 (27.4–31.9) | 22.1 (20.4–23.8) | 26.0 (23.4–28.6) | 18.6 (13.8–23.5) | 28.0 (26.2–29.9) |
| Education | |||||||
| Less than high school diploma | 21.1 (19.2–23.1) | 36.3 (31.2–41.4) | 46.3 (37.0–55.5) | 33.8 (28.2–39.3) | 33.2 (24.8–41.7) | — c | 41.6 (33.6–49.7) |
| High school diploma/GED | 19.0 (17.5–20.4) | 32.3 (29.5–35.2) | 33.0 (28.4–37.7) | 32.0 (28.7–35.4) | 37.7 (33.2–42.3) | 29.8 (20.4–39.3) | 31.5 (26.9–36.1) |
| Some college/associates degree | 14.8 (13.8–15.8) | 23.1 (21.6–24.6) | 26.3 (23.5–29.1) | 21.7 (19.6–23.9) | 22.2 (19.1–25.4) | 16.8 (12.5–21.0) | 24.2 (21.5–27.0) |
| College graduate | 5.6 (5.1–6.2) | 10.5 (9.3–11.7) | 16.9 (14.2–19.5) | 8.7 (7.6–9.9) | 9.6 (7.5–11.8) | 10.1 (6.5–13.8) | 14.7 (12.1–17.4) |
| Disabilityd | |||||||
| Yes | 15.4 (13.5–17.3) | 26.7 (24.9–28.5) | 29.8 (26.8–32.7) | 24.9 (22.5–27.4) | 27.8 (24.5–31.0) | 23.1 (15.6–30.6) | 29.6 (26.5–32.8) |
| No | 13.3 (12.7–13.9) | 19.8 (18.5–21.2) | 23.9 (21.0–26.7) | 18.9 (17.2–20.6) | 22.7 (20.1–25.4) | 13.9 (10.5–17.3) | 19.8 (17.6–21.9) |
| Annual household income | |||||||
| Income at or below federal poverty threshold | 22.5 (20.4–24.7) | 36.7 (33.6–39.7) | 37.6 (32.0–43.2) | 36.2 (32.5–40.0) | 36.8 (31.3–42.3) | 24.8 (14.5–35.1) | 35.9 (31.0–40.9) |
| Income up to 2x federal poverty threshold | 18.5 (16.9–20.1) | 28.1 (25.9–30.4) | 32.4 (28.1–36.7) | 26.6 (23.7–29.4) | 26.9 (22.9–30.8) | 27.8 (15.8–39.9) | 29.6 (26.2–33.1) |
| Income more than 2x federal poverty threshold | 10.9 (10.3–11.5) | 17.0 (15.9–18.1) | 21.4 (19.0–23.8) | 15.6 (14.3–16.9) | 19.4 (16.5–22.3) | 12.9 (9.9–15.9) | 19.5 (17.2–21.9) |
| Marriage status | |||||||
| Married/living with partner | 10.0 (9.2–10.8) | 17.7 (15.9–19.5) | 22.1 (18.6–25.6) | 16.4 (14.5–18.4) | 21.2 (17.1–25.4) | 15.7 (9.9–21.5) | 20.3 (16.9–23.8) |
| Divorced/separated/widowed | 19.6 (17.7–21.6) | 30.2 (27.9–32.6) | 36.7 (32.1–41.3) | 27.8 (24.9–30.7) | 35.8 (29.3–42.3) | 21.1 (14.8–27.4) | 37.9 (32.6–43.3) |
| Never married | 17.1 (16.1–18.1) | 23.4 (22.2–24.6) | 25.9 (23.3–28.4) | 22.4 (20.9–23.9) | 22.4 (20.4–24.4) | 17.5 (12.4–22.6) | 22.5 (20.4–24.7) |
| Health insurancee | |||||||
| Public | 18.5 (16.9–20.1) | 31.6 (29.2–33.9) | 32.7 (28.8–36.6) | 31.1 (27.9–34.2) | 32.7 (28.9–36.4) | 26.5 (15.8–37.1) | 31.7 (27.9–35.5) |
| Private | 10.5 (9.9–11.1) | 15.7 (14.6–16.8) | 19.8 (17.1–22.4) | 14.5 (13.2–15.8) | 17.3 (14.4–20.2) | 13.1 (10.3–15.9) | 17.3 (15.0–19.6) |
| Uninsured | 23.1 (21.2–25.0) | 37.7 (34.4–40.9) | 43.8 (37.3–50.3) | 35.2 (31.5–38.9) | 37.7 (32.9–42.5) | 24.8 (12.7–36.9) | 40.0 (34.6–45.4) |
| Employment status | |||||||
| Full time | 14.4 (13.7–15.2) | 20.5 (19.1–22.0) | 25.6 (23.3–27.9) | 19.0 (17.3–20.6) | 22.0 (19.4–24.7) | 16.0 (11.2–20.9) | 23.7 (21.1–26.2) |
| Part time | 11.6 (10.3–12.9) | 16.4 (14.4–18.4) | 20.0 (15.7–24.3) | 15.1 (12.9–17.2) | 14.6 (10.9–18.3) | 13.8 (8.4–19.3) | 17.9 (14.0–21.8) |
| Unemployed | 23.3 (20.3–26.2) | 35.7 (31.3–40.1) | 36.8 (27.6–46.1) | 35.2 (29.6–40.8) | 35.4 (29.3–41.4) | 29.2 (13.7–44.6) | 32.2 (25.9–38.4) |
| Other/not in labor force | 12.1 (11.1–13.2) | 26.3 (23.6–28.9) | 30.3 (26.6–34.1) | 24.8 (21.4–28.1) | 30.2 (25.2–35.3) | 19.1 (11.1–27.1) | 28.8 (24.9–32.7) |
| Metropolitan statistical areaf | |||||||
| Large metro | 11.6 (10.8–12.4) | 19.3 (18.0–20.7) | 22.9 (20.1–25.8) | 18.2 (16.4–20.0) | 20.7 (17.3–24.0) | 16.7 (10.4–23.1) | 20.4 (17.8–23.1) |
| Small metro | 15.5 (14.5–16.5) | 24.6 (22.7–26.4) | 30.1 (26.9–33.3) | 22.4 (19.8–25.0) | 26.6 (22.8–30.3) | 16.3 (12.3–20.3) | 28.3 (25.3–31.3) |
| Nonmetro/rural | 17.6 (16.2–18.9) | 31.3 (28.3–34.3) | 34.0 (28.4–39.5) | 30.3 (26.7–34.0) | 33.9 (29.2–38.7) | 24.4 (15.6–33.3) | 33.2 (27.8–38.7) |
| Arrested and booked in past 12 months | |||||||
| Yes | 44.1 (38.9–49.2) | 63.0 (56.8–69.2) | 69.9 (60.8–78.9) | 59.3 (51.4–67.2) | 66.2 (53.2–79.2) | 70.2 (43.4–96.9) | 62.1 (52.1–72.1) |
| No | 30.3 (28.8–31.8) | 40.5 (38.2–42.7) | 41.5 (36.1–46.8) | 40.0 (37.2–42.8) | 47.4 (42.0–52.7) | 21.2 (15.7–26.6) | 44.7 (38.5–51.0) |
Table 1. Percentage of Adults Who Currently Smoke Cigarettes, by Mental Health Condition, National Survey on Drug Use and Health, 2019–2020
Abbreviations: GED, General Educational Development.
a Current cigarette smoking was defined as respondents who smoked ≥100 cigarettes in their lifetime and reported smoking part or all of a cigarette in the 30 days preceding interview. Values are weighted percentage (95% CI).
b Past year any mental illness was defined as respondents who reported serious, moderate, or mild mental illness, serious psychological distress, or a major depressive disorder in the past year.
c Estimates suppressed because relative standard error was >30%.
d Disability was defined as respondents reporting any of the following: deaf or difficulty hearing; blind or serious difficulty seeing, even when wearing glasses; serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition; serious difficulty walking or climbing stairs; difficulty dressing or bathing; difficulty doing errands alone such as visiting a doctor’s office or shopping because of a physical, mental, or emotional condition.
e Public and private health insurances are not mutually exclusive; public insurance includes Medicaid, Child Health Improvement Plan, Medicare, Tricare, Champus, Veterans Administration, or some other military insurance.
f Metropolitan statistical areas are based on the 2013 Rural–Urban Continuum Codes (www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx).
| State | AMIb | AMI and smoke cigarettesb,c | No AMI and smoke cigarettesc,d |
|---|---|---|---|
| State median, % | 21.4 | 24.7 | 16.0 |
| Alabama | 20.5 (16.7–25.0) | 35.0 (25.8–45.6) | 19.9 (15.4–25.4) |
| Alaska | 21.1 (17.5–25.3) | 22.5 (15.5–31.6) | 16.4 (13.0–20.4) |
| Arizona | 24.1 (20.7–27.8) | 16.4 (11.2–23.4) | 12.6 (9.2–17.1) |
| Arkansas | 22.3 (18.3–26.9) | 35.3 (26.8–44.8) | 18.3 (14.1–23.3) |
| California | 20.1 (18.6–21.7) | 19.1 (16.0–22.6) | 11.2 (9.6–13.0) |
| Colorado | 23.3 (19.9–27.0) | 20.7 (14.7–28.3) | 12.2 (9.3–15.9) |
| Connecticut | 15.9 (13.1–19.2) | 18.6 (12.7–26.3) | 11.3 (8.0–15.8) |
| Delaware | 20.8 (17.3–24.7) | 24.2 (18.4–31.1) | 17.0 (12.6–22.4) |
| District of Columbia | 23.7 (20.2–27.7) | 19.8 (13.6–27.8) | 18.2 (13.5–24.2) |
| Florida | 16.9 (15.2–18.7) | 23.1 (18.8–28.0) | 15.9 (13.9–18.2) |
| Georgia | 15.7 (13.2–18.5) | 20.0 (14.1–27.6) | 15.3 (12.4–18.8) |
| Hawaii | 17.9 (14.6–21.8) | 22.6 (15.5–31.8) | 15.6 (12.0–20.1) |
| Idaho | 24.9 (21.5–28.6) | 21.1 (15.3–28.3) | 11.8 (8.2–16.7) |
| Illinois | 20.1 (18.0–22.4) | 23.9 (19.1–29.3) | 15.3 (13.2–17.8) |
| Indiana | 20.6 (17.2–24.5) | 35.0 (28.6–42.0) | 20.1 (16.1–24.9) |
| Iowa | 19.7 (16.0–24.0) | 26.4 (19.4–34.9) | 17.7 (13.5–22.8) |
| Kansas | 28.5 (24.3–33.1) | 25.4 (17.9–34.6) | 16.3 (12.3–21.5) |
| Kentucky | 21.6 (18.1–25.6) | 34.2 (26.5–42.9) | 22.3 (18.2–26.9) |
| Louisiana | 21.1 (17.8–24.9) | 42.1 (32.2–52.7) | 20.2 (16.4–24.5) |
| Maine | 22.0 (17.6–27.1) | 23.8 (15.7–34.4) | 15.0 (10.9–20.4) |
| Maryland | 16.6 (14.1–19.5) | 23.4 (17.6–30.3) | 11.5 (8.8–14.8) |
| Massachusetts | 21.4 (17.2–26.3) | 18.6 (10.8–30.2) | 11.7 (9.6–14.2) |
| Michigan | 22.7 (20.3–25.4) | 27.9 (23.7–32.6) | 18.1 (15.5–21.2) |
| Minnesota | 23.6 (20.8–26.7) | 28.4 (21.3–36.8) | 10.5 (8.4–13.2) |
| Mississippi | 22.1 (18.4–26.3) | 32.4 (22.8–43.7) | 22.6 (18.5–27.4) |
| Missouri | 19.8 (17.0–22.9) | 29.6 (23.2–36.9) | 16.4 (13.2–20.1) |
| Montana | 23.0 (18.8–27.9) | 28.6 (21.3–37.1) | 19.1 (16.4–22.1) |
| Nebraska | 23.0 (20.1–26.2) | 30.5 (21.4–41.3) | 12.3 (9.5–15.9) |
| Nevada | 21.2 (17.2–25.9) | 26.7 (19.7–35.1) | 11.9 (8.9–15.9) |
| New Hampshire | 26.3 (22.1–31.0) | 22.0 (15.7–29.9) | 13.8 (10.7–17.6) |
| New Jersey | 17.8 (15.1–20.8) | 17.9 (12.8–24.5) | 12.1 (9.7–15.1) |
| New Mexico | 21.6 (17.6–26.1) | 25.2 (18.6–33.1) | 15.5 (10.8–21.8) |
| New York | 18.7 (17.0–20.6) | 25.6 (21.6–30.0) | 14.0 (12.2–15.9) |
| North Carolina | 18.6 (16.8–20.6) | 27.0 (20.7–34.3) | 17.9 (15.3–20.8) |
| North Dakota | 18.8 (16.2–21.8) | 29.0 (21.2–38.2) | 18.6 (14.6–23.4) |
| Ohio | 24.8 (22.1–27.7) | 34.2 (29.2–39.5) | 19.1 (16.5–22.1) |
| Oklahoma | 29.1 (25.2–33.3) | 28.7 (22.0–36.5) | 21.4 (17.0–26.5) |
| Oregon | 27.5 (23.7–31.7) | 21.5 (15.3–29.3) | 13.8 (10.8–17.4) |
| Pennsylvania | 19.5 (16.9–22.3) | 29.5 (23.1–36.8) | 18.9 (15.5–22.8) |
| Rhode Island | 23.9 (20.2–28.1) | 20.8 (13.3–31.0) | 16.2 (12.1–21.4) |
| South Carolina | 23.3 (19.5–27.5) | 24.7 (18.7–31.9) | 19.9 (16.8–23.5) |
| South Dakota | 18.4 (15.7–21.5) | 28.6 (19.5–39.8) | 19.4 (14.5–25.5) |
| Tennessee | 19.6 (16.2–23.6) | 32.2 (25.3–40.0) | 18.0 (14.1–22.7) |
| Texas | 17.5 (15.7–19.4) | 23.0 (18.9–27.7) | 14.7 (12.9–16.6) |
| Utah | 31.5 (27.8–35.5) | 11.7 (7.9–17.1) | 7.8 (6.1–10.0) |
| Vermont | 22.8 (19.1–26.9) | 27.4 (20.2–36.0) | 10.4 (8.0–13.5) |
| Virginia | 20.4 (17.8–23.4) | 18.9 (13.7–25.5) | 15.2 (12.4–18.4) |
| Washington | 26.1 (22.4–30.1) | 20.1 (15.1–26.3) | 15.4 (12.3–19.0) |
| West Virginia | 28.3 (24.1–32.9) | 31.6 (23.2–41.4) | 20.7 (16.2–26.2) |
| Wisconsin | 21.1 (18.2–24.2) | 22.1 (16.9–28.3) | 16.0 (12.0–20.9) |
| Wyoming | 24.1 (20.3–28.3) | 25.1 (17.7–34.1) | 19.7 (14.7–25.9) |
Table 2. Percentage of Adults Who Currently Smoke Cigarettes, by State and Mental Illness Status, National Survey on Drug Use and Health, 2019–2020a
Abbreviation: AMI, any mental illness.
a Values are weighted percentage (95% CI) unless otherwise indicated.
b Any mental illness was defined as a participant who reported serious, moderate, or mild mental illness, serious psychological distress, and/or major depressive disorder in the past year.
c Current cigarette smoking was defined as those reporting smoking part or all of a cigarette in the past 30 days before interview.
d No serious, moderate, or mild mental illness, serious psychological distress, or major depressive episode reported over the past year.
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Health Sciences Clinical Professor of Family Medicine
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Approximately 1 in 5 adults in the US lives with or experiences a mental health condition each year. These same people are more likely to smoke cigarettes than the population overall [1,2]. Adults with mental health conditions who smoke cigarettes are at increased risk for smoking-related illness and death compared with adults without mental health conditions [3]. Of the approximately 480,000 annual deaths attributable to tobacco products, about 200,000 are among adults who smoke and have a mental health condition [4]. Higher rates of cigarette smoking among adults with mental health conditions is a result of many factors, including targeting by the tobacco industry [5].
Previously reported estimates of cigarette smoking prevalence among adults with mental health conditions were 40.8% for serious psychological distress (2016) [6], 33.3% for any mental illness (AMI) in the past year (2012–2014) [7], 30.5% for major depressive disorder (2022) [8], and 26.9% for regular feelings of depression (2020) [9]. The national smoking prevalence among all US adults, regardless of mental health condition, was 12.5% in 2020 [9]. Prior research has found disparities in cigarette smoking among adults with AMI. Higher smoking prevalence was identified among males, people aged 18 to 49 years, non-Hispanic American Indian and Alaska Native people, people with less than a high school education, people living in poverty, unemployed people, and residents of the Midwest [2,7].
Recently, declines in cigarette smoking among adults with mental health conditions have been reported [8,10]; however, prevalence remains high relative to those without mental health conditions [6–8]. Ongoing surveillance and reporting of recent cigarette smoking estimates among adults with mental health conditions is needed to continue to monitor trends and help identify sociodemographic groups that could benefit from improved tobacco screening, smoking cessation interventions, and mental health treatment [10]. Limited information exists in the literature regarding state-level estimates of cigarette smoking among adults with mental health conditions, although evidence indicates that prevalence varies by region [2]. The most recent comprehensive estimates were reported from 2009 through 2011 [2]. By using data from the 2019–2020 National Survey on Drug Use and Health (NSDUH), we examined the prevalence of past 30-day cigarette smoking (current smoking) among adults with past-year mental health conditions and the prevalence by state of current smoking among adults aged 18 years or older with and without AMI.
